2007 Connecticut AG Report Critical of MH Access for Kids

The 2007 Connecticut Attorney General report on access to mental health care for children [PDF] was quite critical of the role that managed care had on shrinking access to mental health services for children and adolescents. Among the conclusions were:

The results of this survey, both the data collected and the written remarks of child and adolescent psychiatrists, show that countless children and adolescents are receiving inadequate psychiatric treatment, or no treatment at all. Although some patients may be adequately served by psychiatric care focused on the use of medication, a significant proportion of children and adolescents may need treatment that is more intensive, and more expensive, than therapy restricted to the use of drugs. Loss of access to this type of care, what psychiatrists call “relationship-based psychiatric care,” has been happening out of public sight.   

Using low reimbursement rates and bureaucratic hurdles to discourage the delivery of relationship-based care, managed care companies appear to be forcing many Connecticut child and adolescent psychiatrists out of managed care, making it increasingly difficult for many middle income children and adolescents to have adequate access to psychiatric care or to receive the relationship-based treatment that was formerly the standard of care. For many young people, the psychiatric care available appears to be either drugs, or nothing.

One of the four recommended actions included:

Plans must be required to canvas participating providers regularly to determine those providers who are actually available to see enrollees seeking to begin treatment. This information must be made easily available to enrollees so that they are not required to telephone their way through the provider list only to be told that participating psychiatrists are not participating after all, or are not seeing new patients.

Unfortunately, it is common for payers to inflate the apparent size of their network by not keeping them accurate and up-to-date and including providers who no longer accept new patients or who do not take certain age groups or clinical problems. This report found that some payers had advertised networks that were 2, 3, and 4 times their actual effective size. (Is that fraud?)

Homework for the future: How many psychiatrists are in your network? How accurate is it?

One Dad's Perspective

Okay, while our presidential candidates are debating, I thought I would link to an article by a former state legislator.  In "How I Helped Create a Flawed Mental Health System That Failed Millions -- and My Son," Paul Gianfriddo talks about his decades-long attempts to help his ill son, a young man who sounds to have mental health and educational needs that couldn't be met by a system with limitations.

Gianfriddo writes:

The 1980s was the decade when many of the state’s large psychiatric hospitals were emptied. We had the right idea. After years of neglect, the hospitals’ programs and buildings were in decay. But we didn’t always understand what we were doing. In my new legislative role, I jumped at the opportunity to move people out of “those places.” Through my subcommittee, I initiated funding for community mental health and substance abuse treatment programs for adults, returned young people from institution-based “special school districts” to schools in their hometowns, and provided for care coordinators to help manage the transition of people back into the community. 

But we legislators in Connecticut and many other states made a series of critical misjudgments that have haunted us all ever since. 

First, we didn’t understand how poorly prepared the public school systems were to educate children with serious mental illnesses in regular schools and classrooms. Second, we didn’t adequately fund community agencies to meet the new demand for community mental health services—ultimately forcing our county jails to fill the void. And third, we didn’t realize how important it would be to create collaborations among educators, primary care clinicians, mental health professionals, social services providers, and even members of the criminal justice system, if people with serious mental illnesses were to have a reasonable chance of living successfully in the community. 

During the twenty-five years since, I’ve experienced firsthand the devastating consequences of these mistakes.

The story about his son is heart-breaking and there is no happy ending.  I'll leave you to read the whole article and see what you think.  And if you'd like to check it out, Mr. Gianfriddo blogs, often about mental health issues, at Our Health Policy Matters.